title: Alterations in homeostasis after open surgery. A prospective randomized study.
abstract: BACKGROUND
  Alterations in homeostasis, and a subsequent increased risk for postoperative thromboembolic complications, are observed as a result of open surgery. Additionally, the stress response to surgical trauma precipitates a transient hypercoagulable state as well as inflammation. This study was conducted to evaluate the patterns in postoperative alterations of blood coagulation, and to detect their correlations with inflammatory markers.
  
  
  METHODS
  The study included 50 patients with comparable demographic data, who were randomly assigned to undergo abdominal surgery. No previous coagulation disorders were noted. Blood samples were collected preoperatively and 72 h postoperatively. The following parameters were measured: prothrombin time (PT) and activated partial thromboplastin time (APTT); fibrinogen (FIB), D-dimer (D-D), and C-reactive protein (CRP) levels; and platelet (PLT) count. Prophylactic doses of low molecular weight heparin were administered to all patients.
  
  
  RESULTS
  The PT mean value significantly changed from 90.38% before surgery to 81.25% after surgery. No statistical difference was observed between APTT values before and after surgery. FIB levels significantly increased from 381.50 mg/dL preoperatively to 462.57 mg/dL postoperatively. Mean D-D levels also significantly increased from 235.54 μg/L preoperatively to 803.59 μg/L postoperatively. PLT count significantly declined after surgery. Mean CRP levels significantly increased from 12.33 mg/L preoperatively to 44.28 mg/L postoperatively. A strong correlation was observed between D-D and C-RP levels after surgery.
  
  
  CONCLUSIONS
  These results indicate that, despite administering antithromboembolic prophylaxis, a hypercoagulable state was observed following surgery. This state was enhanced by inflammation.
authors.forename: T
authors.initials: T
authors.lastname: Dedej
authors.forename: E
authors.initials: E
authors.lastname: Lamaj
authors.forename: N
authors.initials: N
authors.lastname: Marku
authors.forename: V
authors.initials: V
authors.lastname: Ostreni
authors.forename: S
authors.initials: S
authors.lastname: Bilali
mesh_terms: D000005:Abdomen / Q000601:surgery*; D001777:Blood Coagulation; D001780:Blood Coagulation Tests; D006706:Homeostasis; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies